SELECTIVE MANAGEMENT OF HEPATIC ADENOMAS

Hepatic adenomas are uncommon hepatic neoplasms that may be identified after life-threatening hemorrhage, or as an incidental radiologic fin ding. The incidence of malignant transformation is unknown, and the co rrect treatment strategy is unclear. We examined our 10-year experienc e in the management of 12 patients with hepatic adenomas. Eleven adult s (mean age of 37.6 years) and one 3-month-old were identified. Nine o f 10 adult females (90%) were taking a hormonal preparation at the tim e of diagnosis. Four patients with tumor sizes of 1.0 to 4.0 cm were o bserved after cessation of oral contraceptives. Four patients with les ions of 5.5 to 13 cm underwent surgical resection. Three had malignant transformation, and two of the three had increased Alpha-fetoprotein levels. Four patients presented with acute hemorrhage and were treated initially by hepatic arterial embolization. We conclude that manageme nt of adenomas should be individualized based on their size and mode o f presentation. Patients with lesions less than 5 cm and normal alpha- fetoprotein can be safely observed off oral contraceptives and followe d by radiologic imaging. Lesions >5 cm should be considered for surgic al resection due to the risk of malignancy. Hepatic arterial embolizat ion is a new approach for acute hemorrhage.